APPARATUS FOR MEASURING CARDIAC SIGNALS

Abstract: An apparatus measures the cardiac valve function of a person by using an acoustic signal from the heart and characterizing the signal after signal extraction. The signal is synchronized with the electrocardiographic signal obtained from the heart muscle, in that temporally it is only part of the signal in each period which is of relevance for the characterization. The electrocardiographic signals are too weak and partly swamped by in particular mains-synchronous noise. In order to improve the signal-to-noise ratio the mains-synchronous noise is eliminated by subtraction of a reconstruction of the noise signal. Before characterization of the acoustic signal a weighting is performed, compensating for individual differences in, in particular, the layer of body fat.

Description: Apparatus for measuring cardiac signals. The invention concerns an apparatus for measuring the function of a person's heart valve of the kind which uses an acoustic signal from the cardiac function measured at the outside surface of the body. When physicians listen to heart sounds by means of a stethoscope they i.a. listen for those sounds which are generated by the blood flowing from the heart into the aorta. This sound is caused by turbulence in the flow after passage o a heart valve, and its character gives a good background for evaluating the properties of the heart. It has been shown to b desirable to be able to classify persons, with or without circulatory problems, into several groups, some of which contain persons who will have to be subjected to proper diagnosis. The classification alone requires a vast experience on the side of the physician and becomes expensive to perform. Hence there is a need for a measuring apparatus which is capable of performing this classification. The connection between heart sound measured on the outside of the body and those conditions of a heart which caus the heart sound is well known and is used by trained physician based on experience with the stethoscope sound in the physician's ear. It has been recognized that certain forms of apparatus and signal processing may support the physician in his interpretation of the heart sound, and procedures are know in which may display phonocardiographs on a screen or print them out. Thus the interpreting of the physician is moved from being an auditive problem to being a visual problem: in this case characteristic patterns have to be recognized visually. Furthermore there is now better time for analysis, since it is no longer tied a function in time. It has, however, turned out that the known techniques ar too time consuming to be useful in other than purely experimental measuring situations, which i.a. is caused by the fact that the spectrum analysis used is dependent on integration over many heartbeats, because there are many outer influences on the measured signals and furthermore inter-cycle differences. The known techniques hence do not allow ordinary clinical use, and it is still dependent on learning complex pattern recognition. It is a purpose of the invention to provide an apparatus which is simple to use and which gives a large certainty for correct identification of the heart valve function. This is obtained by an apparatus which is particular in that it comprises a measuring microphone with a preamplifier, a pre- emphasis filter for compensating the degree of obesity of the person, a spectrum analysis function which determines the relative energy distribution in in particular at least one lower and at least one higher frequency range, whereby those parts of the acoustic signal which are to be analyzed are synchronized by means of a signal which is derived from electrocardiographic signals from the person, with or without time delay. It has been recognized in the invention that only throug cooperation between a number of techniques for signal extraction and noise reduction, both for acoustic noise and electric and electromagnetic noise, is it possible to provide an apparatus which functions without the need for human intervention to reject irrelevant information. In a preferred embodiment, in order to extract without time delay a synchronizing signal from the electrocardiographi signals, a non-recursive predictor for noise signals of mains frequency and its harmonics is used, which signals are subtracted from the amplified electrocardiographic signal, followed by a detection based on pattern recognition of the temporal placement of the QRS complex in the electrocardiograp thus cleaned of noise. Stethoscopes as well as microphones or accelerometers placed on the chest collect signals which have been filtered b tissue, in particular fatty tissue, which is interspersed between the sound source, in this case the heart, and the receiver. The signals are weak, and it is necessary to perform heavy digital signal processing in order to obtain reliable results. The signal from the source, i.e. the turbulent flow o blood through a valve, is very broadband, and the average size of the vortices decide the relative content of high frequency energy. It is hence important that the spectral distribution o the sound can be transferred for measurement and classificatio with a signal-to-noise ratio which is as large as possible, an this is obtained by subjecting the directly measured signal to pre-emphasis before signal processing. A further advantageous embodiment is particular in that the pre-emphasis filter has a bandwidth from 0 to 3 kHz, that the amplification is 0 dB to a particular corner frequency, an that it increases at a rate of between 15 and 40 dB per dekade above this, and in that the corner frequency is in the range 30-150 Hz, preferably in the range 80-120 Hz. The amplificatio for the filter used is chosen according to the build and obesity of the test person, in that the steepest curve is chosen for a heavy and overweight person. For a skinny person steepness of between 15 and 24 dB/decade, preferably 16-20 db/decade is chosen, for a person of normal build between 25 and 35 dB/decade, prerably 26-30 dB/decade is chosen, and for a heavy and very obese person between 35 and 42 dB/decade, preferably between 36 and 40 dB/decade. An important prerequisite for correct generation of a synchronizing signal based on electrocardiograhic signals is that these are themselves extracted correctly without disturbing signals. They are commonly swamped by noise signals which display periodicity. It is a well-known problem in the electronic measuring field that the desired signals are hidden in signals from strong noise sources, and numerous methods for separating the signals have been developed. Commonly known methods for separating signal from noise may be to work with narrow bandwidths, including techniques based on phase-locking to the desired signal. These are general methods which generally improve the signal-to-noise ratio. But in the presen case the problem is not as much that the signal is weak in relation to thermic noise or weak in relation to the internal noise of the measuring equipment, but rather that directly interfering signals are present, which may in the worst case overload the measuring circuits. A common source for such signals is radiation from the mains, whereby the desired signals are superimposed with signals which are of mains frequency or its multiples, and which are composed with varyin phase. In this case a commonly used method is to use a filter which has a stopband for frequency components which are harmonics of the mains frequency. Such filters have to be very narrow-band, however, in order to influence the desired signal as little as possible, and thereby they get a large time constant so that their influence is noticed in the time function of the filtered signal instead. Furthermore the damping of the interfering signals is far from sufficient for use with e.g. biological signals. A method which increases the signal-to-noise ratio considerably is based on fundamental frequency extraction and an adaptive filter which is synchronized to the fundamental in order to obtain a synthetic error signal which is subtracted from the noisy signal, but inherent phase shifts only makes a given construction suitable for a very stable mains frequency. In a further advantageous embodiment a circuit for extraction of weak signals by means of a construction which is particular in that a predictor circuit provides a replica of the noise signal which in a subtraction circuit is subtracted from the total noisy signal in order to isolate the desired signal. Further advantageously an embodiment may be particular b letting the predictor being a linear non-recursive predictor. In a further advantageous embodiment the predictor is constructed using a delay line with taps. It has turned out to be essential to use the whole QRS complex in the electrocardiograph for synchronization, even though the user of an apparatus according to the invention would perform a temporal shift of the instant of synchronization, because a correctly extracted time for the QR complex causes a temporally very stable synchronization which is a prerequisite for the signal processing and weighting whic follows. It is for this reason that a pattern-recognition type extraction of the QRS complex is used. The designation QRS is used in its usual meaning for the electrical signals which may be detected in relation to the closure of the mitral valves an the following opening of the aorta valve in the heart during the transition from one cycle to the next. A mathematically optimal detection of the temporal placement of a QRS complex may be based on a cross correlation beetween an instantaneous electrocardiograhic signal and a reference QRS complex, with the requirement that the electrocardiographic signal consists of a pure signal and possibly an uncorrelated noise component. For this reason it is an essential requirement that the input signal to the QRS complex identification has had the correlated interference (i.e. that displaying periodicity) removed by the previous step of extracting of the electrographic signal proper. This has, however, been obtained by e.g. the predictor for the noise signal and subsequent subtraction discussed above. An advantageous embodiment of the invention hence comprises a store for reading-out a reference QRS complex, a correlator for cross correlation between an electrocardiographic signal and the reference QRS complex, an adaptive amplitude detector and a differentiator for determining the time of the appearance of the R peak in the electrocardiographic signal, said time releasing a trigger signal for synchronization of the spectral analysis of the acoustic signal. The invention will be described in greater detail in the following with reference to the drawing, in which Fig. 1 shows an overall block diagram for an apparatus according to the invention. Fig. 2 shows a block diagram of the principle in a circuit for the elimination of mains frequency synchronous noise, Fig. 3 shows an alternative system for the elimination o mains frequency synchronous noise, Fig. 4 shows a block diagram of the principle in a circuit for extraction of the time of the presence of a QRS complex, Fig. 5 shows the transfer function for a pre-emphasis filter according to the invention, and Fig. 6 shows the data which are used for the calculation of the degree of turbulence caused by faulty heart valves. In Fig. 1 are shown the connections for two electrodes which are fitted on the person whose heart is to be examined. The principle of the invention allows the use of a two- electrode ECG system which is a considerable simplification in comparison with the three-electrode system which was hitherto required. The signal from the electrodes is amplified in the the analogue unit 2 in which there is also an automatic amplification control. All other signal processing takes place in the digital domain, for which reason the signal is converte to digital representation after anti-aliasing filtering in block 3. A digital filter with a low group delay restricts the frequency range to the minimum necessary because of the temporal resulution in block 4, and an adaptive filter 5 eliminates mains frequency synchronous noise by means of a non recursive predictor for noise signals of mains frequency or it harmonics, and which are subtracted from the amplified electrocardiographic signal. It has been determined to be advantageous to cascade this function, and hence the signal from the filter 5 is fed to an amplification control circuit 6 and to a filter of the type of 5 as shown at 7. After 6 there my be taken a signal which may be displayed on a monitor as a representation of the time function of a de-noised ECG function. When in the present description the term "signal" is used, usually a digital representation is meant, in the form o tables of bytes which are treated by calculation according to modern signal processing techniques. This means that the functions take place in processors which are controlled by programmes which are typically stored in programmable memories (PROM) . The signal after processing in 7 has obtained a considerably improved signal-to-noise ratio; practical measurement has demonstrated that the signal following block 4 may have a ratio which is worse than between -20 and -60 dB, i.e. a signal which is totally swamped by interfering signals, whereby it following block 7 is better than +30 to +40 dB. Almost all periodicity in the remaining signal has been remove through this treatment. It has been attempted to use two methods for removing interference from the mains, on the one hand a predictor, on the other a fundamental frequency extraction and synthesis of correction signal. The first functions as a linear non- recursive predictor, which may be of the tapped delay line or lattice type. At least two taps are used. The adaptation algorithm functions according to a principle where the energy in the desired signal is minimized, and this function principl is shown in Fig. 2. The other method detects the fundamental frequency of the mains independently and controls a generator for a correction signal which is filtered in an adaptive filte in order that its subtraction causes a reduction in the noise content in the desired signal, and this is shown schematically in Fig. 3. Both methods provide an exellent improvement in the signal-to-noise ratio, but the former can follow slow variations of the fundamental (frequency, phase, and amplitude), e.g. a frequency variation df/dt of 0.2 Hz, and it also allows use of the apparatus with 50 or 60 Hz without adjustment. The latter can only follow small absolute frequenc changes in the order of 0.1 Hz. From the "clean" signal following block 7 it is desired to extract a precise synchronizing signal for use with the selection of the acoustic signal to be processed. This occurs by detection of the QRS complex, and in this the precise determination of the instant of the occurence of the maximum which is termed R. The traditional solution for obtaining a synchronizing signal or trigger signal from this complex is attributed to NASA and is based on an evaluation of the power spectral density, whereby the important information given by the phase is left out of consideration, causing an imprecise trigger signal. The traditional solution utilizes a second order band pass filter with a centre frequency of 17 Hz and a equal to 3.3, followed by amplitude detection. Triggering occurs when the amplitude exceeds ca. 0.7 times the last trigger level. According to the invention cross correlation between the instantaneous cleaned electrocardiographic signal and a reference QRS complex is used in stead which gives an optimal detection of the instant QRS complex. This takes place in the chain of signal processing in block 8 followed by identification of R maximum in block 9. This is shown schematically in greater detail in Fig. 4. The correlator performs as mentioned a cross correlation between the instantaneous ECG and the reference QRS which is obtained by continuously performing linear averaging of the QRS complexes obtained until then. Hence one may speak of an automatic learning function with respect to the specific person and/or measuring rig. At the first start of the measurement cycle a previously stored complex is used, which has been obtained by averaging of a large number of typical complexes. The output signal from the correlator is taken to an adaptive amplitude detector and a differentiator. The amplitud detector outputs a logical signal when the correlator's output signal exceeds a predetermined value which is held as a weighted previously measured value. The differentiator detects local maxima of the curve shape as a switch from a positive value to a negative value of the differentiated signal, and in case several such switches are obtained, a signal is given to the logic circuit at the largest following upon a number of smaller. When both the amplitude condition and the local- maximum conditions are met a synchronization or trigger signal is delivered from block 9. Above it has been described how one may, from a two- electrode electrocardiographic signal, derive a precise synchronization signal for other signals obtained from the sam source, i.e. a heart. These signals are acoustic or vibratory which are predominantly determined at the outside of the chest but which may well be received by probes or catheters which have been led into cavities in the body. In case it is the outside of the chest which transmits the signals it is relevan to use a microphone or an accelerometer for the reception. A microphone receives airborne sound and has hence to be shielde efficiently from the surroundings, while an accelerometer registers the surface movement of the chest, it being however condition that its mass does not influence the measurement. On Fig. 1 it is shown that a microphone or accelerometer signal is fed to a preamplifier with an automatic amplificatio control 10, whereafter the analogue signal is converted to digital representation following anti-aliasing filtering in th block 11. The signal from the sound source itself, the flow through a heart valve to aorta or another artery is exposed to a severe modification because of the passage through fatty, bone, and muscle tissue. This will have the character of a severe low pass filtering. In order to compensate for this a pre-emphasis is performed on the signal received in the block 12. It is a high pass filtering with typical transfer function according to Fig. 5. Since the implementation is digital it is comparatively simple to effect changes by ordinary programming in case fairly uniform populations are to be classified. In order to be able to treat a number of cycles of acoustical signals corrrectly in the evaluation of the relativ energy distribution in a number of frequency bands it is necessary to use time windows and hence a synchronization whic takes a sample of the time function in each cycle which as far as possible contains relevant information only. There must consequently not be added frequency components from the beginning and the end of a sample which are attributable to specifically an uncertainty in the the placement of the beginning and the end, nor from the time function for the sampling itself which is also termed the window function. A prerequisite for this is the precise synchronization pulse described above which has been obtained electrocardiographically. In block 13 the discussed sampling of the pre-emphasized signal is performed. The selected data are processed by means of Fast Fourier Transformation in block 14, and the spectral distribution of the power is performed in block 15. As opposed to earlier thoughts it is in the present case not a question of measuring the presence of specific characteristic frequencies in the measured signal but rather of measuring the relative energy distribution in a lower frequency range and in a higher frequency range. A simple calculation of the energy at high frequencies in proportion to the energy at low frequencies is a good criterion for classifying a population, and this is performed in block 16. In Fig. 6 it is shown how the basis for this calculation is obtained. At a) is shown a signal following block 12, and at b) the corresponding signal following block 13, with a suitable time delay in relation to the synchronization signal from block 9 and with a time window of 150 milliseconds. At c) is shown the averaged energy of such signals from more than 20 heart cycles following block 15. It is shown, how from the total frequency range from « 10 Hz and to 800 Hz there has been taken a frequency range between 20 Hz and 500 Hz which is divided into to ranges at 100 Hz. The total energy in the area below 100 Hz, termed El is added to the total energy in the area above 100 Hz, termed E2, and the addition corresponds to the total energy in the whole frequency range 20 Hz to 500 Hz. The calculating unit 16 performs the calculation E2/(E1 + E2) . The result of this is a number as an expression of the character and degree of defects of the heart valve function. This number is displayed, typically on a monitor. For practical reasons a double logarithmic scale has been used in Fig. 6. In order that the apparatus may be used in conjunction with a specialist, signals following blocks 6, 12, and 15 are fed to a monitor which displays the temporal relationship between the electrocardiographic and the vibrationcardiographi functions. Furthermore a signal is taken following block 12 an digital-to-analogue converted and fed to headphones. Thus it becomes possible to hear a compensated (pre-emphasized) signal simultaneously with visual observation of the electrocardiograph and the acoustic function. It is not shown in the figure that it is possible to influence the time of synchronization by delaying it and by adjusting the width of the sampling in block 13. These two adjustments are shown on the monitor as movement of two cursor lines. Hence it enables the specialist to focus on those phenomena which are of the greatest relevance for a diagnosis. In order to document the performed measurement the shown screen images may be printed o paper.

Claims: P A T E N T C L A I M S 1. An apparatus for the measurement of the heart valve function of a person's heart of the type that utilizes an acoustic signal measured at the outer surface of the body, c h a r a c t e r i z e d i n that it comprises a measurin microphone with a preamplifier, a pre-emphasis filter for compensating the degree of obesity of the person, a spectrum analysis function which determines the relative energy distribution in in particular at least one lower and at least one higher frequency range, whereby those parts of the acousti signal which are to be analyzed are synchronized by means of a signal which is derived from electrocardiographic signals from the person, with or without a time delay. 2. An apparatus according to claim 1, c h a r a c t e r i z e d i n that in order to extract without time delay a synchronizing signal from the electrocardiographic signals, a non-recursive predictor for noise signals of mains frequency and its harmonics is used, which signals are subtracted from the amplified electrocardiographic signal, followed by a detection based on pattern recognition of the temporal placement of the QRS complex in the electrocardiograph thus cleaned of noise. 3. An apparatus according to claim 1, c h a r a c t e r i z e d i n that the pre-emphasis filter has a bandwidth from 0 to 3 kHz, that the amplification is 0 d to a particular corner frequency, and that it increases at a rate of between 15 and 40 dB per dekade above this, and in tha the corner frequency is in the range 30-150 Hz, preferably in the range 80-120 Hz. 4. An apparatus according to claim 2, c h a r a c t e r i z e d i n that a predictor circuit provides a replica of the noise signal which in a subtraction circuit is subtracted from the total noisy signal in order to isolate the desired signal. 5. An apparatus according to claim 4, c h a r a c t e r i z e d i n that the predictor is a linear non-recursive predictor constructed by means of a delay line with taps. 6. An apparatus according to claim 2, c h a r a c t e r i z e d i n that it comprises a store fo reading-out a reference QRS complex, a correlator for cross correlation between an electrocardiographic signal and the reference QRS complex, an adaptive amplitude detector and a differentiator for determining the time of the appearance of the R peak in the electrocardiographic signal, said time releasing a trigger signal for synchronization of the spectral analysis of the acoustic signal.

Inventors: SJOESTROEM SVEND-OLOF, SJOESTROEM, SVEND-OLOF
Applicants: BANG & OLUFSEN TECH AS, SJOESTROEM SVEND OLOF, BANG & OLUFSEN TECHNOLOGY A/S, SJOESTROEM, SVEND-OLOF
Application year: 1994
Main classification: A61B5
IPC codes: A61B5, A61B7, G06F17